Trends in the Prevalence and Antibiotic Resistance of Non-tuberculous Mycobacteria in Mainland China, 2000–2019: Systematic Review and Meta-Analysis

Abstract

Background: China is a high-burden country of tuberculosis. The proportion of diseases caused by non-tuberculous mycobacteria (NTM) has increased, seriously affecting the prevention, control, and management of tuberculosis (TB) and posing a significant threat to human health. However, there is a lack of an organized monitoring system for NTM such as that used for tuberculosis. Comprehensive data on patient susceptibility, dominant species, and drug resistance profiles are needed to improve the treatment protocols and the management of NTM. Methods: Primary research reports of NTM clinical specimens from mainland China published between January 1, 2000 and May 31, 2019 were retrieved from four online resources (BIOSIS, Embase, PubMed, and Web of Science) and three Chinese medical literature databases (CNKI, Wanfang, and Vip) as the Preferred Reporting Items for Systematic Reviews and Meta-Analyses. Results: In total, 339 publications were included in the systematic review, 129 were used in the drug susceptibility analysis, and 95 were used in the meta-analysis. Traditional culture using Lowenstein-Jensen slants combined with P-nitrobenzene acid and thiophene-2-carboxylic acid hydrazine differential medium and proportional method was most commonly used for the isolation, identification, and drug susceptibility testing of NTM in China. The crude isolation rate for NTM among TB suspected cases was 4.66-5.78%, while the proportion of NTM among Mycobacterium isolates was 11.57%. Mycobacterium abscessus and Mycobacterium avium complex were the most common clinical NTM species. NTM only showed general sensitivity to ethambutol, linezolid, clofazimine, amikacin, tobramycin, and clarithromycin. Conclusions: The prevalence of NTM in China has shown a decreasing trend. M. abscessus was replaced as the dominant species by Mycobacterium intracellulare over the course of the study. The geographic diversity of different species showed the effects

Nontuberculous mycobacteria in China: incidence and antimicrobial resistance spectrum from a nationwide survey

“…Mortality of NTM-PD is higher than that attributable to Mycobacterium tuberculosis (MTB) due to inappropriate treatment and high rates of therapy failure [ 3 ]. A meta-analysis indicted the proportion of NTM among mycobacterial isolates in China was higher than most regions in the whole world except that in Northern India [ 4 ]. Although several NTM epidemiology studies in China have been reported, the NTM isolates were primarily obtained from medical institutions and comprised incomplete samples [ 3 , 5 ].…”

“…Therefore, an accurate and rapid method for NTM identification is essential. Because of the differences in local development, the national information associated with NTM prevalence and resistance spectrum in China was obtained by meta-analysis that data was collected in regional areas, which leads to a lack of suitable species identification and DST [ 4 , 7 ].…”

Nontuberculous Mycobacteria in China-incidence and Antimicrobial Resistance Spectrum From a Nationwide Survey

“…Mortality from pulmonary disease caused by NTM is higher than that attributable to Mycobacterium tuberculosis (MTB), due to inappropriate treatment and high rates of therapy failure [3]. A meta-analysis indicted that proportion of NTM among mycobacterial isolates in China was higher than most regions in whole world except that in Northern India [4]. Although several studies of NTM epidemiology in China have been reported, the NTM isolates were primarily obtained from medical institutions and comprised incomplete samples [3,5].…”

“…Therefore, an accurate and rapid method for NTM identi cation is particularly important. In view of the differences in local development, the national information associated with NTM prevalence and resistant spectrum in China was obtained by meta-analysis that data was collected in regional areas, which lead a lack of uni ed methods using for species identi cation and DST [4,7].…”

Sorry for the delay

“…As some of the risk factors for tuberculosis and non-tuberculous mycobacterial pulmonary diseases overlap, it has to be assumed that an unknown proportion of patients reported here as patients with bacteriologically confirmed tuberculosis actually have a different cause of their disease. In a recent systematic review from China, non-tuberculous mycobacteria were isolated from approximately 5% of patients with a suspected diagnosis of tuberculosis [ 4 ]. This limitation adds to the dilemma of diagnostic delay, which is in fact a problem of diagnostic availability, utility and awareness.…”